Hematopathology Practice Questions

Q: Which of the following conditions is NOT associated with microcytic hypochromic red blood cells on a peripheral smear?

Sickle Cell Anemia. The correct answer is **Sickle Cell Anemia (SCA)**. **1. Why Sickle Cell Anemia is the correct answer:** Sickle Cell Anemia is a qualitative hemoglobinopathy caused by a point mutation in the $\beta$-globin chain [1]. It is typically classified as a **normocytic normochromic anemia**. On a peripheral smear, the hallmark findings are sickle-shaped cells (drepanocytes), target cells, and Howell-Jolly bodies (due to autosplenectomy) [3]. It does not cause microcytosis unless it co-exists with another condition like $\alpha$ or $\beta$-thalassemia [2]. **2. Analysis of Incorrect Options (Causes of Microcytic Hypochromic Anemia):** Microcytic hypochromic anemia occurs due to defective hemoglobin synthesis, which can be remembered by the mnemonic **TAILS**: * **Iron Deficiency Anemia (A):** The most common cause worldwide. Low iron leads to decreased heme synthesis [2]. * **Lead Poisoning (B):** Lead inhibits enzymes (ferrochelatase and ALA dehydratase) in the heme synthesis pathway, leading to microcytosis and characteristic **basophilic stippling**. * **Sideroblastic Anemia (C):** Characterized by the body's inability to incorporate iron into hemoglobin despite having sufficient iron. It results in **ringed sideroblasts** in the bone marrow. * *(Note: **T**halassemia and Anemia of **C**hronic Disease are the other major causes [2]).* **3. NEET-PG High-Yield Pearls:** * **Mentzer Index:** (MCV/RBC count) helps differentiate Iron Deficiency Anemia (>13) from Thalassemia (<13). * **RDW (Red Cell Distribution Width):** Is typically **increased** in Iron Deficiency Anemia but **normal** in Thalassemia trait. * **Gold Standard for IDA:** Bone marrow aspiration showing absent iron stores (Prussian blue stain), though Serum Ferritin is the best initial non-invasive test.

Q: Which CD marker represents the leucocyte common antigen?

CD 45. ### Explanation **Correct Option: D (CD 45)** CD 45 is known as the **Leucocyte Common Antigen (LCA)**. It is a transmembrane protein tyrosine phosphatase expressed on the surface of **all hematopoietic cells**, except for mature erythrocytes and platelets. In diagnostic pathology, CD 45 is the primary immunohistochemical (IHC) marker used to differentiate **lymphomas/leukemias** from non-hematopoietic tumors like carcinomas or sarcomas. **Analysis of Incorrect Options:** * **A. CD 14:** This is a specific marker for **monocytes and macrophages**. It acts as a co-receptor for bacterial lipopolysaccharide (LPS). * **B. CD 15:** This marker is expressed on **Reed-Sternberg cells** (in classical Hodgkin Lymphoma, along with CD 30) and is also found on mature **granulocytes**. * **C. CD 23:** This is a low-affinity IgE receptor [1]. It is a key marker for **B-cell Chronic Lymphocytic Leukemia (CLL)** and is used to differentiate it from Mantle Cell Lymphoma (which is CD 23 negative) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Pan-B cell markers:** CD 19, CD 20 [1]. * **Pan-T cell markers:** CD 3 (most specific), CD 2, CD 5, CD 7 [1]. * **NK cell markers:** CD 16, CD 56. * **Hairy Cell Leukemia:** Characterized by CD 11c, CD 25, and CD 103 [1]. * **Stem cell marker:** CD 34 (used to identify blasts in acute leukemia). * **Memory Tip:** If a tumor is "LCA positive," think Lymphoma; if "Cytokeratin positive," think Carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 598.

Q: The presence of the Philadelphia chromosome is associated with a worse prognosis in patients with which of the following diseases?

Acute lymphoblastic leukemia. **Explanation:** The **Philadelphia chromosome (Ph+)**, resulting from the reciprocal translocation **t(9;22)(q34;q11)**, creates the **BCR-ABL1** fusion gene. This gene encodes a constitutively active tyrosine kinase that drives uncontrolled cellular proliferation. **1. Why Acute Lymphoblastic Leukemia (ALL) is the correct answer:** In ALL, the Philadelphia chromosome is found in approximately 25-30% of adults and 3-5% of children. Historically, Ph+ ALL was associated with a **very poor prognosis**, characterized by low remission rates and high relapse risk [1]. While the introduction of Tyrosine Kinase Inhibitors (TKIs) like Imatinib has improved outcomes, it remains a high-risk feature that often necessitates intensive chemotherapy followed by Allogeneic Stem Cell Transplant. **2. Analysis of Incorrect Options:** * **B. Acute Myelogenous Leukemia (AML):** Ph+ AML is rare (<1%). While it indicates a poor prognosis, it is not the classic association tested in the context of prognostic stratification compared to ALL. * **C. Chronic Lymphocytic Leukemia (CLL):** The Philadelphia chromosome is not a feature of CLL. Common cytogenetic markers in CLL include del(13q), del(11q), and del(17p). * **D. Chronic Myelogenous Leukemia (CML):** The Philadelphia chromosome is the **hallmark** of CML (present in >95% of cases) and is essential for its diagnosis. It defines the disease rather than indicating a "worse prognosis" relative to other CML cases. **High-Yield Clinical Pearls for NEET-PG:** * **Molecular Weight:** In CML, the BCR-ABL protein is typically **p210**, whereas in Ph+ ALL, it is more commonly **p190**. * **Treatment:** The standard of care for Ph+ leukemias involves **TKIs** (Imatinib, Dasatinib, Nilotinib). * **Most Common Translocation in Childhood ALL:** t(12;21) (ETV6-RUNX1), which carries a **favorable** prognosis.

Question 1

BCR-ABL1 gene fusion is seen in all of the following conditions except?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Acute myeloid leukemia

Answer

Chronic myeloid leukemia

Answer

Acute lymphoblastic leukemia

Question 2

Which of the following conditions is NOT associated with microcytic hypochromic red blood cells on a peripheral smear?

Accepted Answer

Sickle Cell Anemia

Answer

Iron Deficiency Anemia

Answer

Lead poisoning

Answer

Sideroblastic anemia

Question 3

Which type of Hodgkin's disease is commonest in females and associated with an excellent prognosis?

Accepted Answer

Nodular sclerosis

Answer

Lymphocyte predominant

Answer

Lymphocyte depleted

Answer

Mixed cellularity

Question 4

Which coagulation test is typically prolonged in hemophilia?

Accepted Answer

Activated partial thromboplastin time (APTT)

Answer

Prothrombin time (PT)

Answer

Clotting time (CT)

Answer

Fibrin degradation products (FDP)

Question 5

Hot agglutinin is found in all conditions except:

Accepted Answer

Mycoplasma infection

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Methyl dopa

Answer

Rheumatoid arthritis

Question 6

Which CD marker represents the leucocyte common antigen?

Accepted Answer

CD 45

Answer

CD 14

Answer

CD 15

Answer

CD 23

Question 7

Bence Jones proteinuria may be seen in:

Accepted Answer

Mu heavy chain disease

Answer

Alpha heavy chain disease

Answer

Gamma heavy chain disease

Answer

Epsilon heavy chain disease

Question 8

The presence of the Philadelphia chromosome is associated with a worse prognosis in patients with which of the following diseases?

Accepted Answer

Acute lymphoblastic leukemia

Answer

Acute myelogenous leukemia

Answer

Chronic lymphocytic leukemia

Answer

Chronic myelogenous leukemia

Question 9

Which of the following is NOT a characteristic feature of multiple myeloma?

Accepted Answer

Hypercalcemia

Answer

Hyperuricemia

Answer

Increased serum alkaline phosphatase

Answer

Monoclonal M band

Question 10

Splenic auto-infarction is typically seen in which of the following conditions?

Accepted Answer

Sickle cell disease

Answer

Splenic amyloidosis

Answer

Thalassemia

Answer

Gaucher disease

Hematopathology — MCQs

Hematopathology — MCQs

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